Can someone give me their experience with Cigna PPO?
Highest: 320 Surgery: 247 Current: 183 Goal: 145
First you need to get something from Cigna that your policy does cover WLS if it is medically necessary. That if you have comorbities or in poor health. If you get a denial letter, don’t lose hope. All that I need is the six month diet than I should be approved. Then the fun begins. The doctor that will do my WLS is out of network provider. The closest one that is in network is 125 miles. You see the catch is that there is in network general surgeons in my area that does not do the WLS. My out of network doctor is listed as general surgeon too, but does the WLS. Cigna has paid for my first consult with the out of network doctor with in network benefits.
Yes call member services. Write down the time and the name of the person that you talked to. If you don’t like the answer that you get call them back.
I would go see you PCP and start the six month diet process while you figured was is covered. I am pasting information that I got from Cigna about WLS coverage and what they want in a diet. Let me know if this helps. Jane
CIGNA HEALTHCARE COVERAGE POSITIONBariatric surgery is explicitly excluded under many [but not all] CIGNA HealthCare benefit plans andmay be governed by state and/or federal mandates. Please refer to the applicable benefit plandocument to determine benefit availability and the terms and conditions of coverage.Unless excluded from the benefit plan, this service is covered when the following medicalnecessity criteria are met.CIGNA HealthCare covers bariatric surgery using a covered procedure outlined below asmedically necessary when ALL of the following criteria are met:. The individual is = 18 years of age or has reached full expected skeletal growth AND hasevidence of one of the following:> BMI (Body Mass Index) = 40 for at least the previous 12 months.> BMI (Body Mass Index) 35-39.9 for at least the previous 12 months with at least one clinicallysignificant co-morbidity, such as a serious cardiopulmonary problem, Type 2 diabetes,hypertension, coronary artery disease, or pulmonary hypertension that has failed to respondadequately to appropriate medical management.. Active participation within the last one to two years in one physician-directed weight-managementprogram for a minimum of six months without significant gaps. The weight-management program mustinclude monthly documentation of ALL of the following components:> Vital signs including weight> Current dietary program> Physical activity (i.e., exercise program)> Behavioral interventions to reinforce healthy eating and exercise habits> Consideration of pharmacotherapy with U.S. Food and Drug Administration (FDA)-approved weight-loss drugs, if appropriateFor individuals with lifelong, morbid obesity, participation in a program within the last five years issufficient if documentation of six months is available and reasonable compliance with the weightmanagementprogram over an extended period of time can be demonstrated. However, dietprograms/plans alone, such as Weigh****chers®, Jenny Craig® and similar plans, are notconsidered physician-directed weight-management programs and do not meet this requirement.Similarly, physician-directed programs consisting exclusively of pharmacological managementare not sufficient to meet this requirement.. Evaluation by a multi-disciplinary team including:> A thorough medical history and physical examination.> An evaluation by a licensed mental health care professional that specifically addresses anymental health or substance abuse diagnoses, the emotional readiness and ability of thepatient to make and sustain lifestyle changes, and the adequacy of their support system.If an individual is already in behavioral health treatment, consultation with their treatingclinicians should also be sought.> A thorough nutritional evaluation by a physician or registered dietician experienced in the issuesof bariatric surgery, who has had a meaningful conversation with the individual regarding thedietary and lifestyle changes required to insure a successful outcome over time.Bariatric Surgery Procedures:
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